I just switched to an omnipod a couple weeks ago from mdf. Right now I have two profiles 0.50 from 12am to 6am and 0.65 throughout the rest of the day.
I am noticing a jump of about 80 points from 2am to 5am. Assuming this is dawn phenomenon.
If my ISF is 40 do I adjust a block between 12-3am to be equal to 2 whole units to counteract the DP?
I also tend to spike 40 points upon waking up. Any suggestions around this? It has been frustrating trying to basal test as I seem to get different results depending where the pod is.
Are adjustments usually recommended in .10 increments?
so, I would say the basal correction wouldn’t be as simple as just translating your ISF into a total extra insulin and then adding that into your basal rate. For one, 0.5 units/hr translates to a peak concentration of insulin greater than that. And for another, once you have a slightly higher basal rate, that may suppress liver dumping of insulin – so you probably don’t need 2 units of insulin over 3 hours.
I’d try bumping up your basal to something like 0.55 units and see how much you rise. If that doesn’t work, try 0.6. If you go low, you’ve gone too far. If you go low four or five hours later, consider backing off the higher basal rate an hour earlier. and so on.
Does that make sense to you?
Based on your previous Tresiba dosage, I think doing the full 2 units would be too much.
I would suggest - just as a starting point - going to 0.70 units from 12:30am to 4am. See how that works for you.
Turn up your CGM alarm sound until you get it figured out.
You can either ramp up your basal an hour before you wake up, or just take a bolus when you wake up.
It depends on if you always wake up at the same time and if you always spike when you wake up. If your schedule is consistent, and your spike is consistent, the basal increase can work. But the bolus when you wake up is the safer option.
I would get the 2am spike figured out first though. You don’t want to change too much all at once.
Thanks everyone, crazy night last night I was all ready for an overnight basal test…fours hour in from my last meal I am at 140 at 11:15. About to go to bed notice an arrow on dex going down. Dropped 100 points in an hour.
Went to bed at 115am at 150, woke up to pee around 5ish noticed I was then at 250. Thoughts on what happened? My basal was 0.60 from 12a-6am. Did my low cause the high? Was it a late DP? Was it me waking up?
I think it is more likely a combination of insufficient basal, plus DP and waking up. Not the low.
Keep in mind that the Somogyi rebound effect that people sometimes reference was something that came about from findings by the doctor (Michael Somogyi) in the 1930’s. It is not really a proven phenomenon and is somewhat refuted nowadays. So I don’t think a low caused it.
Based on your CGM, I would ramp the basal up a little more around 3:30am.
Perhaps add the disclaimer, if your blood sugar consistently does this. I know not everyone has the pleasure of a hormone gyrating teenager, but we usually wait until we see something consistently for a week before we “whack the mole”
Like Eric insinuated, if you are newly diagnosed then your pancreas could be the problem on the bedtime low.
Here’s what I see in your graph. From noon to 6pm, the BG is steadily falling, with jumps up after crossing below your low-limit. If repeated on other days, unless you can explain it by insulin boluses given before noon, and again at 1:45pm, and again at 4pm, this pattern strongly suggests too much basal during that period, and you treated the low alarms with glucose. In general, if your BG is falling “all by itself” at the same time period each day, start thinking that you have too much basal. Make small adjustments to basal and watch what happens for 2 or 3 days (enough to see a pattern rather than jumping to conclusions, because so many extraneous things can affect our BG.) Unless you’ve had lots of experience adjusting your basals, I’d be more inclined to suggest small steps like TiaG said rather than the larger steps Eric had in mind.
I don’t know why you lost your CGM from 6pm to 8:45. Was that a sensor end, and new or restarted sensor? I’m seeing a bit of jitter in the graph around 10pm to 11pm. Is this a new sensor or a restarted old one? If it is a new sensor, the quick drop from 11pm to midnight could be completely spurious, because a new Dex sensor sometimes does that all by itself until it settles in. — In which case take a fingerstick to see if you need glucose, but don’t recalibrate yet, wait 12 hours before recalibrating a new sensor so it has time to settle in and start giving good data. It often will “fix itself” from that temporary false low: if you force a calibration during that temporary false low it will just start giving false high readings later after it fixes itself.
In the overnight part of the graph I see a bowl shape. There’s a slow drop from 1:15 or so, reaching a minimum around 3:15, and then a slow climb til 6am followed by a rapid climb. Keep in mind that when we make a basal adjustment, it needs to start an hour or two before the problem it’s supposed to correct, because it takes that long for the changed basal to kick in. Now if this pattern of slow drop followed by slow rise and rapid rise is repeated for a few days around the same times, then compared with your current basal I’d slightly decrease the basal starting at midnight, then slightly increase the basal around 1:30am, and have a second increase around 5am. Watch what happens and make small adjustments.
The faster rise around 6am looks to me like dawn phenomenon, if you were still sleeping then. If you actually were getting up at 6, then this is not DP, it is “feet hitting the floor” phenomenon. For that, the advice is as Eric said: just give a bolus immediately upon waking up, or if you always wake up at the same time every day, you could put that in as a basal step.
I just recently started with Omnipod and the Dexcom. I noticed those nighttime highs immediately with the basal set at a fixed level through 24 hours. Daytime seemed to be just fine but showed a bit too many “lows” for my taste. It is definitely not “dawn phenomenon” which I see with a spike at 5am sharp with regular time up at 6:15am (damn, I would like to have that extra hour). My “rise” was steady and steep, coming from a 120 bg around 10pm, 3 hours after dinner, steady until about 1am with no extra food or boluses since 6:30pm/7pm, shooting up steadily to 200 plus. My theory is that it is directly related to the food you eat. If you are eating somewhat healthy food where the carbs are difficult to break down, you would see that healthy dinner being broken down and absorbed in your bloodstream about 8 hours later. You can easily test this with refined sugars and raw sugar cane sugars and other natural sugars that are hard to break down for your body. This of course makes your bolus and basal somewhat tricky. The bolus is there too early and the basal is not strong enough to catch that release. I kind of worked it out in little basal adjustments of .1 units increases from 12am-8am and “extended boluses”. But I had more success with the adjustment in basal. It took about 2 weeks in slow fine-tuning in little increments but currently I see a rise of about 20-30 points from a 1am -4am110 bg reading and than the 15-20 jump to wake up that immediately drops down by itself. At this point I am happy with those 130-140 wake up results and don’t want to overdue it not to run into those nighttime lows and my Average runs at 121 with a deviation of 44.
I have been diabetic for 16 years but just recent to the omnipod.
Does DP always occur at the same time or does it matter when you go to bed?
What about waking up? Is going to the bathroom two hours early and then going to bed going to trigger a “wake up” spike?
I spoke to my endo and we went to 0.60 from 12-3am and 0.75 from 3am to 9am and then 0.65 the rest of the day for now.
I think DP is closely related to the sleep cycle but I’d have to research that a bit to be sure.
The wake up spike is simply your liver responding to the change from dormant state to active state. You have not eaten for hours. You have no fuel from meals. Your liver says, “Airtas is moving around. I better give him some fuel for that!”
Yes you can spike from getting up to go to the bathroom. You can even spike after taking an afternoon nap and waking up.
I did have to put in a new sensor hence the disconnect. All the CGM was verified with a finger stick so everythng is fairly accurate. That was a bad day overall but I believe you are correct I think I do need some less basal between 12p-6p.
What is strange I did basal tests for that segment and one day I dropped 60 points and the other I dropped 10. Will have to keep testing.
I seem to have Novolog do some strange things like drop me 100 points in the 4th hour. I did mow the lawn earlier that day (riding mower though) so who knows. I appreciate the help. I will post some more CGM on more stable days if you don’t mind evaluating.
That’s the thing about managing our blood sugar. Our bodies have general tendencies, but they are not machines and don’t always to the same thing even when we think they should. So set the basal as best you can so that it generally does the right thing. Specifically, if you sometimes drop 60 mg/dL during a time period, and other times drop only 10, back off on the basal a bit, and try to get it so that it sometimes drops 25 and other times rises 25, because neither one of those will cause an emergency. Then just take small bits of carb or insulin when your BG is drifting and you’re ready to guide it back in range.
Folks here will tell you what they see, but presumably your goal is to learn to see it for yourself. One source for lots of explained examples is the book Sugar Surfing by Steve Ponder. But for me it’s pretty simple. If I see a pattern where my blood sugar usually is dropping all by itself during the same time of day, I think about reducing my basal a little bit. Similarly, if my blood sugar tends to rise all by itself, I’ll think about increasing the basal. “All by itself” means not as a consequence of a preceding meal or correction or exercise. Basal testing is the standard way to do it, but I’m not so careful. If I find that I’m usually going high after meals I’ll strengthen my insulin to carb ratio. If I find that my corrections routinely send me too low I’ll back off on the strength of the correction ratio. And if my BG drifts all by itself I’ll adjust the basal. I probably make changes 4 times per year. With one small adjustment every second or third day I can get it dialed in to a satisfactory degree. If I were to make multiple simultaneous adjustments, or make them too large or frequently, probably instead of homing into a good setting I’d just get further and further out of wack, and I don’t need that aggrevation so I take my time.
It looks like it was going ok until around 3:30am, at which point it started climbing. If this happened to me around the same time for two or three nights, I’d increase the basal a small amount starting at 2am and see what happens over the next few nights.
I find that once I’m high (like 200) it can take a long time and lots of insulin to come back down. So I try not to get that high in the first place by intervening sooner. That means having a good overnight basal schedule, and also having somewhat tighter CGM limits. If the CGM is going to have to wake me anyway because of a high, I’d rather that it happen at 140 which is easy to fix. As you point out, at 180 or 220, the correction is going to be slower and more difficult.
Does sleeping make you less insulin sensitive during a correction?
I guess the part I don’t understand is if I have an 80 point spike how does a small adjustment for a couple hours do much?
80 points is generally 2 units for me so wouldn’t I need to increase by maybe a unit an hour for that 2 hour window?
I don’t know if sleeping always makes people more insulin resistant – our son’s highest ISF is at night (315+)
BUT if we give him insulin during his nap, we can pile it on and it won’t have an effect until he’s sleeping. I actually suspect it’s about how blood and interstitial fluid may be flowing when you’re asleep/lying down…but that’s just my guess.
DP is related to your circadian rhythm, which is pretty regular. I think resetting it takes something like shift work or traveling across several time zones rather than one day going to bed an hour or so earlier or later than normal.
Certainly my experience, but I haven’t looked into scientific backup. If I correct with 2U during the day, I’m soon dropping. If I correct with 2U during the night, nothing happens; I’ll need at least 4 or 6 to make a change.
For me, the amount of basal increase to prevent a rise is much smaller than the amount of correction insulin to repair the rise after the fact.
Anyway, I’d suggest to make a small basal changes, step by step, and see what happens in your body. In my body, surprisingly small basal changes will solve a BG drift. If you decide you would rather increase your basal by a whole unit per hour be aware of the possibility of plummeting BG overnight.
It just depends on the timing of it. If you light a few leaves on fire, you can put it out immediately with a cup of water. If you wait a few minutes, you need a bucket.
1/2 a unit before you climb is different than 1/2 a unit after you have spiked.
